Basic principles for spectacle prescription in children |Dr Sameera

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Basic principles for spectacle prescription in children

If every ophthalmologist in his/her practice donates one day in a month to screen kids with a COVER TEST and gives appropriate glasses, STRABISMUS WOULD DISAPPEAR 

except the congenital convergence insufficiecy and Essential infantile Et (causing a large angle XT & ET respectively)

Some basic principles for spectacle prescription in children:

1) After checking visual acuity in either eye, PERFORM A COVER TEST FOR NEAR (at 33 cm) and then at FAR distance ( 3 m).
2) If an ESOPHORIA OR ESOTROPIA is detected, even though the patient has a 6/6 VA in either eye, do an ATROPINE REFRACTION.
3) Give a FULL PLUS correction if the child is under 6 years age.
4) If the child is more than 6 yrs, do a SUBJECTIVE REFRACTION once the affect of atropine wears off i.e after 1 week and give MAXIMUM PLUS THAT THE CHILD CAN TOLERATE.
5) If on Cover Test, EXOPHORIA or EXOTROPIA is detected, then do a refraction with Cyclopentolate.
6) If you get a MINUS REFRACTION, GIVE ALL THE MINUS SPHERO-CYLINDER along with convergence exercises.
7) If you get a plus refraction, then change the cylinder to a MINUS IN THE OPPOSITE MERIDION (as illustrated by previous example).
8) If there is a zero refractive error but the child has an exophoria, if you do not treat it with a minus sphere of -0.75 D, this phoria will soon become a tropia.
 Similarly, an esophoria with zero refractive error will become a tropia soon if no plus glasses are given.
I hope these are very clear instructions.
best regards


Dr. Sameera Irfan, FRCS
Consultant Oculoplastic Surgeon & Strabismologist,
Mughal Eye Trust Hospital,
Lahore, Pakistan


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